HomeMy WebLinkAboutBuilding 03-0078
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Jan-lO-03 Ol:06P
P.Ol
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Oat!;: Rec' d
Please type or print and sign at bottom)
ADDRESS
While
Pmk
Yellow
file
City
ApplIcant
PERMIT NO. 0 :3 --00121
,
/~337
8YL(:z-y
p-t:
!(d.
ZONING (office use)
LEGAL DESCRIPTION (office use only)
ADDITION I)
SD
LOT : 1 BLOCK
OWNER
(Name)
-/W1~~ Sf~
5337
~ f().
(Phone) q~'2..) ttY7-3 is]
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
ROt1UTr ~ S-nu~
Do t.J 6 /l.{).55 0 V-
10 7 '10 I1da~ /f;7..d, II e
(Phone)
(Phone)
~S2.-) Ktf'/~"SI f
X If
~ I /f/lN ~ S;YI:D
.
Bloo~
TYPE OF WORK
o New Construction
ODed: o Porch ~e-Roofing
o Fireplace OAddition OAlteration
PROJECTCOST/VALUE (exdudingland) S ~ ~
ORe-Siding
OLower Level Finish
o Misc.
DUtility Connection
I hereby certifY that I have furnished information on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or
authOrized agent for the above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted plans. I am aware that the buiIdmg official can revoke this permit for just cause Furthermore, I hereby agree that the city official or a deSignee may
enter upon the property to perform needed inspections.
X )tD;j1ilA~~
8e Z-33 7
Contractor's License No.
Date
Permit Valuation
PermIt Fee S
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee S
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$
Water Meter Size 5/8"; I";
Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
#
#
Building Official
Date
This Application Becomes Your Building Permit When Approved
TIlls IS to certify that the rcquest In the above applicatIOn and accompanying documents L. In accordance with the City Zonmg Ordinance and may proceed as requested. TIllS document
when S18n~d by the City Planner conslltutes a tempurary Certificate of Zoning compliance and allows construcllon to commence Befoe. occupancy. a Certificate of Occupancy mu~t be
iSJut"d
Planning Director
Date Special Conditions. if any
24 hour notice for all inspections (952) 447.9850, fu (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372